What is a prostate biopsy?


A prostate biopsy is the only medical procedure with which prostate cancer can be diagnosed conclusively.

It is performed by a urologist or radiologist when one or more anomalies have been detected in the prostate. The necessity of a biopsy is determined by a digital rectal exam, PSA test or, more recently, an MRI scan.

The exam consists of removing small samples of the organ, before analysing them under a microscope to establish the presence or absence of cancer sites, their aggressiveness and respective sizes.

Typically, ten or so samples are taken under ultrasound guidance using a fine needle approximately 1 mm in diameter and a biopsy gun. Positioned in the rectum, the ultrasound probe allows the doctor to see the prostate and guide the insertion of the needle before making the puncture.

What is a prostate biopsy? A source of anxiety for many patients, prostate biopsies nonetheless remain a common non-painful procedure among men over the age of 50, generally performed on an outpatient basis under local anaesthetic and leading to a fast recovery.

Diagnosing prostate cancer – 2 biopsy types

A pathology affecting almost one in seven men worldwide, prostate cancer care relies, above all, on the early, accurate and reliable diagnosis of the disease.

The prostate biopsy therefore constitutes a critical stage in the patient journey. At present, there are two types of biopsy in practice.

The “blind” biopsy

The vast majority of prostate biopsies today are carried out transrectally by means of a 2D ultrasound probe. During the procedure, the doctor aims to take 12 evenly spread samples in order to maximise the chances of finding an infected site. There are two main reasons why these biopsies are referred to as “blind”:

  • Conventional ultrasound techniques are not particularly effective when it comes to visualising potential cancer sites directly on the ultrasound scanner.
  • The ultrasound guidance tool only allows for 2D visualisation, making it difficult to take an even spread of organ samples.

The development of multiparametric Magnetic Resonance Imaging (MRI) of the prostate has considerably improved the sensitivity and specificity of prostate cancer diagnoses – See the related studies. Given the excessive constraints associated with biopsies performed directly under MRI, an alternative has now emerged, enabling real-time integration on the ultrasound scanner of information based on MRI sequences: MRI-US fusion.

The “fusion” or “targeted” biopsy

SIU Medicine’s experience with MRI/US Fusion technology:

The development of the fusion of MRI images (interpreted by a specialist radiologist) and ultrasound images has revolutionised biopsy procedures. Thanks to fusion technology, the urologist is now able to:

  • Detect potential cancer sites before carrying out the biopsy thanks to MRI test
  • Locate suspect areas on the ultrasound image in real time during the biopsy
  • Guide the biopsy needle directly into the suspect areas on the MRI
  • Record the position of the biopsies performed in 3D prostate mapping (information that is essential for diagnosis and follow-up)
  • All with the precision of a few millimetres

Result: A detailed diagnosis leading to personalised patient care.

Example of Fusion biopsy procedure:

MRI/US contour of the prostate

1. Radiologist defines suspicious lesion on the MRI

mri ultrasound fusion prostate biopsy image

2. MRI and 3D Ultrasound Image Fusion

Targeted Prostate Biopsy

3. Targeted Biopsy

3D prostate mapping biopsy

4. 3D Mapping

→ Further information about fusion biopsies

→ Watch a detailed Prostate Fusion Biopsy explanation (in french)

Despite its performance and the clinically proven benefits, prostate fusion biopsy is still not the most common practice. The main reasons for which it is not yet widespread are the acquisition cost, the need for access to an MRI scanner, and the novelty of the technology.

→ Locate a urologists in USA or on the Koelis Solution Locator.

The MRI-US targeted biopsy procedure in detail

The prostate biopsy procedure in 4 stages

Below is the chronology of a prostate bx procedure (using MRI-Ultrasound fusion).

Important note: Naturally, this “standard prostate biopsy procedure” depends on a number of factors: national guidelines, the doctor’s knowledge and training, as well as the equipment used. Prostate biopsy techniques may vary from one practitioner to another.

Stage 1: Prediagnosis (screening) of cancer
Stage 2: Prostate biopsy procedure
Stage 3: Analysis of samples and diagnosis
Stage 4: Choice of treatment

Transperineal (TPUS Bx) or transrectal (TRUS Bx) biopsy

During the prostate biopsy procedure, the sampling needle may be inserted via the rectum or through the perineum.

The decision will be made by the doctor in consultation with the patient. A particular technique may be favoured according to the patient’s wishes, the doctor’s experience, the location of the necessary biopsies and the available medical equipment.

The most common practice is a transrectal biopsy under local anaesthetic.

Having long been restricted to general anaesthesia, transperineal procedures are now possible under local anaesthetic thanks to recent technological advances (cf. KOELIS Trinity). On account of the reduced risk of infection after a biopsy, use of this method is continually increasing throughout the world.

To find out more about these two methods:

→ Transrectal biopsy

→ Transperineal biopsy

Local or general anaesthesia

Local or general anaesthesia?
This choice is also made by the doctor, who will decide upon the most suitable protocol on the basis of their particular methods and the individual patient in question.

In order to lower the risk of morbidity and the side effects associated with general anaesthesia, the biopsy may be conducted under local anaesthetic regardless of the method used: transrectal or transperineal.

What are the risks? Complications and side effects

The primary complications during the prostate biopsy procedure are very much related to the anaesthesia. A prostate biopsy generally takes place without consequence, yet side effects may be observed:

  • Pain and discomfort around the sampled area(s)
  • Difficulty urinating
  • Bleeding of the prostate – Presence of blood in urine/sperm
  • Side effects due to general anaesthetic
  • Risk of infection (lower for transperineal biopsy)

Post-biopsy results

Once the prostate biopsy is complete, the samples taken are sent to a doctor specialising in the analysis of cancer cells: the anatomical pathologist.

This specialist will then determine whether or not cancer tissue is present in each sample. Any cancer cells are identified and classified according to their aggressiveness and size using a Gleason Score.

Detailed information about Gleason Score

KOELIS™ technology for Prostate Cancer biopsies

For over a decade KOELIS, The Prostate Care Company, has assisted urologists and radiologists from around the world in their routine clinical practice providing the latest technology. In order to bring personalized answers to every patient in the respect of their quality of life, we’ve developed KOELIS Trinity™ the first image-based cartographer. This system allows physicians to perform precise and targeted transperineal or transrectal MRI/US fusion guided biopsies under local or general anesthesia.

“Quality management in patient diagnosis”

It is equipped with the exclusive Organ-Based Tracking Fusion™ technology which guarantees the accuracy of the biopsy. Without changing the usual clinical practices, this technique leads to increase control from biopsy localizations specifically for each patient and, consequently, to higher detection rate and stronger basis for further prostate cancer management.

To locate a clinic equipped with our solutions: Discover our interactive map.